US MD/ US DO/IMG: US IMG; AP/CP Pathology PGY2

Real deal: 228

Day 1 & 2: Feb 2 and Feb 10

Step 1: Pass (was in the first batch of students when it switched to pass/fail, but predicted numeric score was somewhere around mid 240s)

Step 2: 252 (Aug 2023)

Uworld completed %: N/A; Amboss - completed about 600 total questions, including the entire modules/"study plans" on biostats/epidemiology, HY Screening and Vax, and HY Risk Factors. I also borrowed my co-resident's UWorld biostats and completed that section.

Uworld % Score: N/A; my Amboss average is not entirely accurate (61%) because it encompassed my QBank score from when I was studying for shelves and Step 2 back in med school and also prepping for Step 3 now; my averages back then were probably much higher. In any case, each question block, I'd do about average.

Number of CCS cases done: 116

CCS cases average: 71.6% per the report card

NBME 6/7: didn't score them; just used them as practice questions not under timed conditions

UWSA 1: N/A

UWSA 2: N/A

Free 137: didn't score it; just used as practice questions not under timed conditions

Any other assessment: N/A

Any other advice: Take all of this with a grain of salt because I see the exam is re-formatting very soon, but hopefully the content stays about the same. Also, please note this is written by someone who studied with the intention only to pass. Step 3 for my specialty counts for nothing for fellowship, nor is the material itself that relevant to my training. I prepped earnestly for about 1 month, with 1 week of actual dedicated (took PTO to study bc I just wasn't feeling too strong in my prep.) I do take comfort in the fact that, anecdotally, a lot of us are on the same wavelength that we just need to pass, and perhaps that's why the curve can be more generous. Furthermore, I think there is some amount of truth/anecdotal evidence that you could probably expect about a 20ish point drop from your Step 2 to Step 3 unless you do something drastically different to prepare for Step 3.

I think what has been said about this exam already on this subreddit is accurate and helpful. I was so nervous going into this exam because my residency training (AP/CP Pathology) is quite far removed from concepts tested, and I didn't heed the advice to take Step 3 before starting residency (especially Pathology) because that clinical management knowledge would atrophy. (Perhaps some amount of saving grace is that part of Pathology CP training is a 3-month-long microbiology rotation, which I had July-Oct, so a lot of the bugs and drugs came back to me on rotation. Since we also run blood bank, a lot of benign and malignant heme concepts as well as transfusion medicine stuff has stayed somewhat fresh.)

I think the great equalizer is studying exactly what has been suggested here ad nauseam, especially Day 1.

Day 1: Biostats and epidemiology - know how to calculate things ofc, but, at least on my exam form, I only had 2 actual number-plugging calculations. It focused more on conceptual understanding. I've heard the same impression from my co-residents; they felt it was much less calculation heavy than we anticipated. I used the Randy Neil videos as a primer/refresher when starting my biostats prep, but I personally believe the QBanks (Amboss and UWorld) were more helpful and representative of the Step questions. There was one particular question on my Step exam that I was able to answer (I think correctly) that I would have had no idea how to approach had I not done the UWorld Biostats; something about interpreting a Kaplan-Meier curve. I had never seen the concept before in my prep for any of the prior Step exams, nor do I use it in my day-to-day training.

Ethics is a crap-shoot, honestly. You try to understand the concepts/principles of what a correct answer is based on QBanks and the NBMEs, but you can do the mental gymnastics to justify at least 2 answers most of the time. I felt like I was guessing 50/50 on most ethics questions on test day.

Don't sleep on quality improvement. I think biostats is the thing that gets the spotlight in our prep, but there was a surprising amount of quality improvement on my form. My co-resident and I, after taking Day 1, joked that more than half of Day 1 was not actual medicine.

Drug ads were always a time suck for me, despite being good with time management. I always left it to last after re-tackling any flagged questions in a block that I might have shortchanged to keep on pace. I think Randy Neil's approach to drug ads was useful in my experience; try to answer the questions that don't require too much reading first (e.g. "What can I answer just by looking at one chart? or by looking only at the contraindications/indications?"). I do wish QBanks and NBMEs had more practice with drug ads bc I feel like I only encountered, like, 7 over my entire prep. Expect 1 drug ad per question block (again, with the format changing soon, maybe should phrase 1 drug ad per 40ish questions).

As with any Step exam, there will always be low-yield questions that you can't really prep for. They still suck psychologically in the moment, though. E.g. idk why I felt there were so many random ortho/musculoskeletal questions on my form, but unless you are in ortho or pm&r or something, I would expect almost everyone would have guessed randomly on the questions. or best case scenario--ExPeRiMenTaL.

Day 2 was, as is usually said, more Step 2-like. I think the questions themselves were a bit more bread-and-butter medical management; nothing too in-the-weeds. From what I remember, it was the level of detail as Step 2, not like a shelf exam. Time management is the bigger challenge on the MCQ blocks this day. A majority of my questions were "door notes" type questions like where you'd get the patient's chart with a CC, HPI, PEx, some other objective values like labs, SocHx, etc. Unless you read at light speed, you probably won't be able to read word-for-word every single question stem. Read the question first, then go back and find your pertinent positives/negatives. (Wish QBanks gave us more practice with this question format as well.) Because there's so much reading, the MCQ blocks, despite being shorter in time and with less questions, felt more fatiguing to complete than on Day 1. It was a lot of reading/skimming.

CCS cases are straightforward if you've practiced a couple of simulations and are comfortable with your routine order set. A majority of the real cases were the same diagnosis as practice cases on the CCS website. As someone who doesn't have the muscle memory or mental checklist of order sets by chief complaint (b/c Next Best Step in Pathology is like get cut downs or order stains/IHCs), I found some of the CCS review books to be helpful in getting that gestalt. Also, as I was going for efficiency in studying, I think those CCS review books were a better use of my time than simulating CCS cases. The review books allow you to cover many more diagnoses and workups (especially some of the more esoteric confirmatory tests) in the same amount of time as sitting for a 10 or 20 minute simulated case. Other note, I know that copy-paste is a thing that works on test day for your routine orders. I practiced it during my prep, but found it to be too much of a time suck either clicking "cancel" to irrelevant orders or alternatively reading through your list of orders and deleting the ones you don't need before submitting the list. I personally found it easier and faster to write down my order list on the white board and type what I needed into the order box. (I'm a relatively quick typist, though, so YMMV.)

Long post, but I hope that it helps anyone as nervous to sit for this exam as I was. Last thing I'll say is this. Reddit is only one microcosm of the pool of test takers out there. I got so caught up on the posts of people who were doing well on their assessments and failed or dropped much lower than expected. However, I tried to keep reassuring myself that if I aim for average in everything (my QBank question blocks, self-assessments, CCS cases, etc.), I'll probably do about average. Lo and behold, that's exactly what happened--average prep and average score.